The independent inquiry into the high level of deaths at Mid Staffs found evidence of appalling patient care resulting from a preoccupation with cost cutting. In the current harsh financial climate in the NHS, a lot of trusts will again become preoccupied with cost cutting. How will we ensure that this time it does not lead to “appalling” patient care?
Well, one way will be how trusts respond to complaints.
A report last year by the national audit office found one in seven people using the NHS were dissatisfied with the service, but the majority did not make a formal complaint. The report states that many people did not bother to complain because the process was “time consuming, complex and ultimately futile”.
Is it worth complaining about health and social care services? Will anything be done as a result? Most people who do complain simply want an apology or an explanation; they are not looking for compensation or for staff to be disciplined.
Complaints tend to fall into two categories: those about indifferent, unhelpful, uncaring staff, and those about the system which often seems to make no sense to patients and is perceived as designed to frustrate.
Frontline staff - be they doctors, nurses or social workers - are often equally frustrated by the system. They are sympathetic but convey the message - “it is beyond our control”, “it’s not our fault” and “complain if you want but I doubt it will make a difference”. Managers have a tendency to focus on staff. If only people were better trained; if only we were better at recruiting the right people; if only it was easier to get rid of unsuitable staff - then things would be as they should be.
When I lost my bags at Gatwick Airport, it was clear that this was not an isolated incident but a regular feature for those changing planes at Gatwick. Often, there is simply not enough time to take the bags off one plane and transfer them to the connecting flight; a delayed flight incurs a large financial penalty for the airline and so flights frequently take off without passengers’ baggage. Clearly, this is a fault of the system. However, individual complaints are unlikely to change the system - you can always fly with a different airline and use a different airport.
It doesn’t work like this in the public sector. Of course, you can go private for healthcare. My brother did. When both the toilet bowls were cracked, broken and leaking their smelly contents onto the ward where he had been admitted with a severe bowel problem, he did not make a formal complaint in writing to the chief nursing officer. Instead, he said “get me out of this hell” and his wife, with the help of the consultant, did so.
Sometimes, complaining to the right person gets a quick fix. Before my father-in-law could leave hospital he had to wait for his drugs to come from the pharmacy. He waited and waited but the ward could not say when the drugs would come. After a couple of hours of sitting on a hard seat in a drafty corridor, my wife, who had gone to collect him, put him in a taxi and waited alone for the drugs. She waited for most of the afternoon, checking at regular intervals with the ward staff if there was any indication when the drugs would arrive; there wasn’t. She offered to go down to the pharmacy herself; she was told there was no point. Eventually, even her patience ran out. As a senior manager, she understood that there was no point blasting off at the ward staff; instead she rang the hospital switchboard and insisted on speaking to the chief nursing officer. She explained the situation in a calm and reasonable manner, which resulted in a commitment to send the drugs by taxi to my father-in-law later that evening.
In both cases, there were clearly problems with the system rather than the staff.
People would have more confidence in the public sector complaints system if they thought that complaints were treated seriously and resulted in changes to the system. All too often the impression given is make a fuss and you will be viewed as a nuisance and make a formal complaint and you will get a standard response, an empty apology and a vague commitment to raise the issue with the staff concerned.
It does not have to be like this. Complaints can be used as an opportunity to improve services. Complaints can be analysed with a view to learning from them and making changes to the system. Complaints are also an early warning to management that things are going wrong, that cost savings are having an unintended, yet definite and unacceptable impact on patient care.